Tattoo Removal

Tattoos are simply permanent drawings or designs made in the skin. They are created when pigment is implanted into the middlemost layer, known as the dermis. In the past, and still today among amateur tattoo artists, the pigment was inserted by pricking the skin with handheld needles that were coated with ink. These days, professional tattoos artists, however, use an electric tattoo machine whose needle tips are coated with the chosen pigment. There are as many as 100 different colored inks to choose from. The needles hammer up and down into the skin with a motion much like that of a sewing machine and drive the pigment down into the desired locations to create what amounts to true works of art upon a canvass of skin.

At one time, the very mention of the word tattoo conjured frightening images of gang members, hardened convicts, right wing hate groups, and bizarre religious cultists. That image changed, however, as tattoos burst into mainstream Americana during the past twenty years. The presence of approximately four thousand tattoo parlors nationwide attests to their enormous popularity, particularly among young people. And, it is estimated that greater than ten million Americans possess at least one tattoo.

With the passage of time, not everyone remains happy with their foray into body art. Perhaps as many as half of all individuals sporting tattoos grow to regret their youthful indiscretion. What appeared cool and "in" on a forearm at age sixteen can prove an impediment to getting hired as an airline stewardess at age twenty-six. And a soaring eagle with its wings spread wide and coarsing up the side of the neck may look macho at seventeen, but altogether unacceptable to a conservative Wall Street brokerage firm at age twenty-seven. And, of course, an "I love Sally" heart-shaped tattoo replete with Cupid's arrow spread over John's outer arm is not likely to go over very well with the next love of his life, Jane.

It may be fairly easy to get a tattoo applied, but it's safe to say, it's much harder to get one removed, and, for that matter, much more expensive. Prior to the introduction of light-based therapies, a variety of procedures were used for getting rid of them. These included dermabrasion, salabrasion, cryotherapy, chemical peeling. and surgical excision.

Dermabrasion involved the use of a motor-driven wire brush to abrade the skin surface; salabrasion, the use of coarse salt crystals; cryotherapy, freezing with liquid nitrogen; and medium-depth chemical peels, tha application of caustic materials. Each of these techniques relied upon stripping away the epidermis, the topmost layer of the skin, and exposing the pigment-laden dermis. Following exposure, the ink would be extruded as part of the healing process.

Surgical excision skirted the issue of dealing directly with the embedded pigment. Instead, if the lesion were small, it was cut out entirely and the resulting wound sutured together. If it were very large or its location difficult to work with, the removal was done in stages, allowing each surgical wound to heal before proceeding to excise another part. In general, these methods were successful at obliterating the tattoo, but at least some degree of scarring was inevitable. It was a trade-off--an acceptable scar in place a highly visible and undesirable tattoo.

Lasers and other light therapy devices, such as the Infrared Coagulater (IRC), are the treatments of choice today. Lasers work by emitting short, intense pulses of light that pass through the skin and target the ink. The energy from the laser light fragments the large particles of tattoo pigment enabling the body's natural immune system to more easily scavenge the pigment and carry it away. This process usually takes several weeks, and multiple treatment sessions are often necessary to achieve maximal clearing.

Since black pigment absorbs all wavelengths of light, it is ironically the easiest pigment to remove. Colors, such as green, do not absorb as well, and sometimes a variety of lasers, with varying wavelengths, are needed to effectively treat a multicolored tattoo.

Potential complications include permanent scarring, temporary or permanent loss of pigment or excessive pigmentation. Fees for laser treatments may range from $1000-$3000 or more, depending upon the number of treatment sessions required, and the size, shape, colors, and location of the particular tattoo.

IRC uses non-laser infrared light to heat the area containing the pigment. It is quick and easy to perform, and generally requires fewer treatments than lasers. Most small tattoos can be treated successfully in one to three sessions. IRC's efficacy also does not depend upon the particular color of the pigments involved. For these reasons, it is my favorite method for dealing with small tattoos.

The procedure is quick and simple. The area is first numbed with local anesthesia. Next, very short pulses of infrared light are directed at the tattoo in a gridlike fashion, leaving tiny spaces between each treated site. Since each burst of energy is just a fraction of second, an entire treatment session requires only a few minutes to complete. It is within the course of the next few weeks, as he wound heals, that the pigment is extruded.

To complete the removal, the intervening spaces are generally treated between two to four weeks later. Fees for a series of three sessions generally run about $1500. As with laser treatments, potential complications include scarring and temporary or permanent pigmentary changes. Most people, however, are quite gratified and relieved to be free finally of their tattoos. The accompanying figure demonstrates a tattoo before and eight weeks following final treatment with IRC.